Prostate treatment: HIFU ini Chiang Mai?

[pachoderm]

Hello friends, Does anyone know if a treatment for prostate cancer called HIFU, is available in Chiang Mai?

HIFU= High Intensity Focused Ultrasound.

From all reports, it is a highly effective alternative treatment to prostate surgery.

Thanks.

[elektrified]

Available in Bangkok at Samitivej. Mixed reviews... new treatment, not much data, less effective than other treatment. Maybe move to health forum and ask Sheryl?

[Mekong Bob]

any reports on daVinci robotic prostatectomy surgery in Chiang Mai?

CM Ram now has robot.

[pachoderm]

So has Sripat got the robot, will cost about $17,000 US for the pleasure, not! But this is prostatectomy, not HIFU,

Alot of resistance my many doctors to HIFU - despite widespread use in Europe and USA.
Thanks for the heads up on Samitivej.

[OneZero]

Dr Banakit is the "Go To" guy with respect to prostrate in CM (perhaps in Thaiiland). I believe he is head of Urology Dept at CMU. A few years back I saw him on Thai channel TV in BKK demonstrating the robotic device / procedure. Besides CMU hospital he has a schedule at RAM, plus his own office hours 1700-1900 on Kaew Nawarot Rd (a small little shop house type affair on left going out of town just over the bridge). Of course he's not the cheapest Urologist around, but if your requirement requires the expertise he is the guy to see.

[Mekong Bob]

So has Sripat got the robot, will cost about $17,000 US for the pleasure, not! But this is prostatectomy, not HIFU,

Alot of resistance my many doctors to HIFU - despite widespread use in Europe and USA.

Thanks for the heads up on Samitivej.

Pachoderm,

Do prostate patients need a biopsy before HIFU and after HIFU (to determine progress)? How many HIFU treatments generally required?

Why do many doctors "resist" using? Not effective? Not a good alternative to surgery?

Robotic surgery is about $17K (550K baht). About 3 times more expensive than a standard "open" prostatectomy, I would guess.

Agonizing decisions for patient, treatment vs surgery, open surgery vs robotic surgery, etc.

[pachoderm]

I do not know all the facts yet, so you may have to do some research yourself on the dreaded 5 minutes of excruciation they call a prostate biopsy!

Here is one description of HIF:

High Intensity Focused Ultrasound
HIFU with the Sonablate® 500 is a non invasive treatment option for prostate cancer that uses a transrectal probe to focus ultrasound waves in the prostate. In the focal zone, the temperature is rapidly elevated which causes tissue destruction. During HIFU, the entire prostate is treated or ablated. The entire gland is ablated to make sure there is less chance for cancer to recur in tissue that might have been left in the area. HIFU with the Sonablate® 500 takes between one to three hours and is performed as an out-patient procedure under a general, spinal, or epidural anesthesia. Recovery is minimal. There is a catheter that is inserted during the procedure that is usually worn for one to four weeks as the body heals so the bladder can empty properly. People usually are up and walking around within hours after HIFU and can return to a normal lifestyle within a couple of days. HIFU with the Sonablate® 500 has very low rates of both impotence and incontinence. Focal HIFU for small cancers appears to be feasible, with an even further decreased risk of impotence and/or incontinence."

Check also these links:

http://www.internationalhifu.com/hifu-treatment/patient-stories.html
https://www.melbournehifu.com.au/whosuitable.aspx

[elektrified]

As I understand it, Dr. Bannakit is one of two surgeons in Thailand who can use the robot. The one he uses is at the prostate center at CMU. Didn't know they had one at C.M. Ram. They just had a show on television about a month ago broadcast from CMU prostate center where they discussed it. And yes, 550,000+ THB.

[elektrified]

I do not know all the facts yet, so you may have to do some research yourself on the dreaded 5 minutes of excruciation they call a prostate biopsy!

I had one (Dr. Bannakit). Never felt a thing. Took more like 20 minutes.

[fvw53]

I had prostate cancer at the age of 65 after a blood test showed that in one year PSA had gone up from 4.7 to 7.4 : to fast for my age.

I went back to my home country (EU) where a urologist used a Da Vince laser to remove the prostate : no consequences on erections or on urine continence but it took a few months.

A proverb says that the good doctor is the one who cures you...

In Thailand I am also worried of surgical intervention because some hospitals are on the stock market ...if your home country has government subsidised medical care I strongly advise you go back and ask for a second opinion.

Edited November 17, 2014 by fvw53

[cheeryble]

I remembered reading about the remarkable results achieved with HIFU at the Royal Marsden in London, one of the world leading cancer centres (never miss an opportunity to say God bless the NHS and all universal health services).

Zero incidence or very low indeed on incontinence and impotence.

Just did a quick search and the brief results are incorporated in a whole load of other stuff worth knowing including risk charts to help one decide whether to make one's money last or spend as fast as possible.

Have to say it's mostly more comforting than one might expect.

http://www.royalmarsden.nhs.uk/SiteCollectionDocuments/gp-education/20120427/alan-thompson.pdf

Very sorry to hear of the great expense for robotic of 550kbt.....can guess it's for use-leasing of the machine.

Happily again this is done without billing on Britain's NHS.

Edited November 17, 2014 by cheeryble

[pachoderm]

thanks Cheeryble for you recommendations and links, I had also seem similar reports from UK.

To FVW53, I am afraid you are right. Hospitals here in Thailand are set up for farang business and hence recommendations of procedures that cost the same as western countries seem to becoming more commonplace. They also seem to err on the conservative side of healing modalities, i.e. surgery, without other options to choose from. May I ask what country you had the da Vinci laser done in and were you able to claim it on the health system?

[xylophone]

So has Sripat got the robot, will cost about $17,000 US for the pleasure, not! But this is prostatectomy, not HIFU,

Alot of resistance my many doctors to HIFU - despite widespread use in Europe and USA.

Thanks for the heads up on Samitivej.

Pachoderm,

Do prostate patients need a biopsy before HIFU and after HIFU (to determine progress)? How many HIFU treatments generally required?

Why do many doctors "resist" using? Not effective? Not a good alternative to surgery?

Robotic surgery is about $17K (550K baht). About 3 times more expensive than a standard "open" prostatectomy, I would guess.

Agonizing decisions for patient, treatment vs surgery, open surgery vs robotic surgery, etc.

Yes, agonising decisions indeed.

I can only comment on the open surgery versus robotic surgery subject as I did much research on this. The problem with the open surgery as performed prior to the Da Vinci robot was with the possibility of damaging nerves and tissue around the prostate, thereby resulting in incontinence and erectile dysfunction, whereas the robotic procedure is much more precise and is supposed to bypass many of these problems.

I do know of people who have had brachytherapy and who have achieved good results with it, so perhaps this is also worth further research on your behalf.

Good luck with whatever you decide.

[pachoderm]

thanks for your input, most appreciated!
this site on HIFU gives lots of info on the procedure, it seems to be far superior to surgery , with less side effects.
Anyone contemplating surgery, I would urge them strongly to consider this alternative.

http://www.hifu-planet.co.uk/hifu-ablatherm-treatment/HIFU-treatment

[xylophone]

So has Sripat got the robot, will cost about $17,000 US for the pleasure, not! But this is prostatectomy, not HIFU,

Alot of resistance my many doctors to HIFU - despite widespread use in Europe and USA.

Thanks for the heads up on Samitivej.

Quote: "A lot of resistance my many doctors to HIFU - despite widespread use in Europe and USA".

When I was investigating various procedures, I got the "inside running" from my surgeon friend on why there is resistance to many of the newer procedures available and it basically comes down to what they call the, "gold standard".

To try and put it in a nutshell, the "gold standard" is the procedure which has been around for many years, usually decades and has been tried and tested over the years with proven results, no matter how barbaric it may seem compared to modern procedures.

As an example, have a look at the instrument used to perform the TURP and it is quite a frightening sight to think that this piece of equipment, originally designed over 50 years ago (perhaps a little slimmer these days) is going to be pushed up inside the urethra. Just to look at this and think about it brings tears to one's eyes!

Green light laser surgery was one procedure I was looking at, and even though it has been in use for quite a few years now, many of the traditional urologists would still fall back on the "gold standard" procedure, whilst dismissing this one as "unproven" or similar terminology.

Trying to weigh the situation up, I suppose one cannot fault the specialists for erring on the side of caution, however I wonder if this cautious approach can sometimes hold back new treatments and processes, which in turn/time could become the "gold standard"?

[cheeryble]

thanks for your input, most appreciated!

this site on HIFU gives lots of info on the procedure, it seems to be far superior to surgery , with less side effects.

Anyone contemplating surgery, I would urge them strongly to consider this alternative.

http://www.hifu-planet.co.uk/hifu-ablatherm-treatment/HIFU-treatment

Worth bearing in mind that for HIFU the prostate needs to be <40cc in size. (From your Australian site)...which I don't think is that large for an ageing prostate.

I'm guessing it could be about the focal distance for the HIFU and heat build up.

The article also seems to say you can have the prostate reduced in size THEN get HIFU.

[zzdocxx]

Mr. Pachoderm

Don't mean to be nosy and don't know if you have already stated this, but:

What is your diagnosis ?

[cheapcanuck]

Sorry for the bad news.

[thaibeachlovers]

On ‎11‎/‎17‎/‎2014 at 1:06 PM, pachoderm said:

I do not know all the facts yet, so you may have to do some research yourself on the dreaded 5 minutes of excruciation they call a prostate biopsy!

I had that and would not call it excruciating. Uncomfortable certainly, but tolearable. Don't be alarmed to see bloody stools after though.

 

Personally, if I could go back, I'd have anything other than an open prostatectomy. A life destroying procedure. 

They tell you of the potential side effects, but the reality was worse than what I expected.

[canopus1969]

1 hour ago, thaibeachlovers said:

I had that and would not call it excruciating. Uncomfortable certainly, but tolearable. Don't be alarmed to see bloody stools after though.

 

Personally, if I could go back, I'd have anything other than an open prostatectomy. A life destroying procedure. 

They tell you of the potential side effects, but the reality was worse than what I expected.

Appreciate your candid opinion, thank you